|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$35.78
|
|
|
Service Code
|
HCPCS J0167
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: ASR ASR |
$34.70
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.50
|
| Rate for Payer: BCN Commercial |
$29.50
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.62
|
| Rate for Payer: Healthscope Commercial |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$35.78
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.41
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.48
|
| Rate for Payer: Priority Health Narrow Network |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.48
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$35.78
|
|
|
Service Code
|
HCPCS J0167
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: ASR ASR |
$34.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.62
|
| Rate for Payer: Healthscope Commercial |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$35.78
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.41
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.48
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$18,293.21
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,775.76 |
| Max. Negotiated Rate |
$18,293.21 |
| Rate for Payer: Aetna Medicare |
$11,342.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,178.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,178.64
|
| Rate for Payer: BCBS MAPPO |
$11,342.91
|
| Rate for Payer: BCN Medicare Advantage |
$11,342.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,342.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,342.91
|
| Rate for Payer: Mclaren Medicare |
$11,342.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,910.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,044.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,477.20
|
| Rate for Payer: PACE Medicare |
$10,775.76
|
| Rate for Payer: PACE SWMI |
$11,342.91
|
| Rate for Payer: PHP Commercial |
$12,477.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,342.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,293.21
|
| Rate for Payer: Priority Health Medicare |
$11,342.91
|
| Rate for Payer: Priority Health Narrow Network |
$14,634.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11,342.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,342.91
|
| Rate for Payer: UHC Exchange |
$17,581.51
|
| Rate for Payer: UHCCP DNSP |
$11,342.91
|
| Rate for Payer: VA VA |
$11,342.91
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$10,912.28
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$6,688.17 |
| Max. Negotiated Rate |
$10,912.28 |
| Rate for Payer: Aetna Medicare |
$7,040.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,800.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,800.23
|
| Rate for Payer: BCBS MAPPO |
$7,040.18
|
| Rate for Payer: BCN Medicare Advantage |
$7,040.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,040.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,040.18
|
| Rate for Payer: Mclaren Medicare |
$7,040.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,392.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,096.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,744.20
|
| Rate for Payer: PACE Medicare |
$6,688.17
|
| Rate for Payer: PACE SWMI |
$7,040.18
|
| Rate for Payer: PHP Commercial |
$7,744.20
|
| Rate for Payer: PHP Medicare Advantage |
$7,040.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,084.28
|
| Rate for Payer: Priority Health Medicare |
$7,040.18
|
| Rate for Payer: Priority Health Narrow Network |
$8,067.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7,040.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,040.18
|
| Rate for Payer: UHC Exchange |
$10,912.28
|
| Rate for Payer: UHCCP DNSP |
$7,040.18
|
| Rate for Payer: VA VA |
$7,040.18
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$366.31
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$366.31 |
| Rate for Payer: Aetna Commercial |
$329.68
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: ASR ASR |
$355.32
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$302.03
|
| Rate for Payer: BCN Commercial |
$302.03
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cofinity Commercial |
$344.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Healthscope Whirlpool |
$366.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$329.68
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Nomi Health Commercial |
$300.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$8.04
|
| Rate for Payer: PHP Medicaid |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.04
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$11.33
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP DNSP |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$366.31
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$274.74 |
| Max. Negotiated Rate |
$366.31 |
| Rate for Payer: Aetna Commercial |
$329.68
|
| Rate for Payer: ASR ASR |
$355.32
|
| Rate for Payer: BCBS Trust/PPO |
$300.82
|
| Rate for Payer: BCN Commercial |
$300.82
|
| Rate for Payer: Cash Price |
$293.05
|
| Rate for Payer: Cofinity Commercial |
$344.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.05
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Healthscope Whirlpool |
$366.31
|
| Rate for Payer: Mclaren Commercial |
$329.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Nomi Health Commercial |
$300.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.36
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$333.27
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$333.27 |
| Rate for Payer: Aetna Commercial |
$299.95
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$323.28
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$274.78
|
| Rate for Payer: BCN Commercial |
$274.78
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Commercial |
$313.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$323.28
|
| Rate for Payer: Healthscope Whirlpool |
$333.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$299.95
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.28
|
| Rate for Payer: Nomi Health Commercial |
$273.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$333.27
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$333.27 |
| Rate for Payer: Aetna Commercial |
$299.95
|
| Rate for Payer: ASR ASR |
$323.28
|
| Rate for Payer: BCBS Trust/PPO |
$273.68
|
| Rate for Payer: BCN Commercial |
$273.68
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Commercial |
$313.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Healthscope Commercial |
$323.28
|
| Rate for Payer: Healthscope Whirlpool |
$333.27
|
| Rate for Payer: Mclaren Commercial |
$299.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.28
|
| Rate for Payer: Nomi Health Commercial |
$273.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.28
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$666.55
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$666.55 |
| Rate for Payer: Aetna Commercial |
$599.90
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$646.56
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$549.57
|
| Rate for Payer: BCN Commercial |
$549.57
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$533.24
|
| Rate for Payer: Cash Price |
$533.24
|
| Rate for Payer: Cofinity Commercial |
$626.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$646.56
|
| Rate for Payer: Healthscope Whirlpool |
$666.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$599.90
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.57
|
| Rate for Payer: Nomi Health Commercial |
$546.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.91
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$666.55
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$499.91 |
| Max. Negotiated Rate |
$666.55 |
| Rate for Payer: Aetna Commercial |
$599.90
|
| Rate for Payer: ASR ASR |
$646.56
|
| Rate for Payer: BCBS Trust/PPO |
$547.37
|
| Rate for Payer: BCN Commercial |
$547.37
|
| Rate for Payer: Cash Price |
$533.24
|
| Rate for Payer: Cofinity Commercial |
$626.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.24
|
| Rate for Payer: Healthscope Commercial |
$646.56
|
| Rate for Payer: Healthscope Whirlpool |
$666.55
|
| Rate for Payer: Mclaren Commercial |
$599.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.57
|
| Rate for Payer: Nomi Health Commercial |
$546.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.57
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$83.56 |
| Rate for Payer: Aetna Commercial |
$75.20
|
| Rate for Payer: ASR ASR |
$81.05
|
| Rate for Payer: BCBS Trust/PPO |
$68.62
|
| Rate for Payer: BCN Commercial |
$68.62
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$81.05
|
| Rate for Payer: Healthscope Whirlpool |
$83.56
|
| Rate for Payer: Mclaren Commercial |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.53
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$83.56 |
| Rate for Payer: Aetna Commercial |
$75.20
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$81.05
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$68.89
|
| Rate for Payer: BCN Commercial |
$68.89
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$81.05
|
| Rate for Payer: Healthscope Whirlpool |
$83.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$75.20
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$125.33 |
| Rate for Payer: Aetna Commercial |
$112.80
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$121.57
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$103.33
|
| Rate for Payer: BCN Commercial |
$103.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Commercial |
$117.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$121.57
|
| Rate for Payer: Healthscope Whirlpool |
$125.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$112.80
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Nomi Health Commercial |
$102.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$125.33 |
| Rate for Payer: Aetna Commercial |
$112.80
|
| Rate for Payer: ASR ASR |
$121.57
|
| Rate for Payer: BCBS Trust/PPO |
$102.92
|
| Rate for Payer: BCN Commercial |
$102.92
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Commercial |
$117.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Healthscope Commercial |
$121.57
|
| Rate for Payer: Healthscope Whirlpool |
$125.33
|
| Rate for Payer: Mclaren Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Nomi Health Commercial |
$102.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.29
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,201.66
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$901.25 |
| Max. Negotiated Rate |
$1,201.66 |
| Rate for Payer: Aetna Commercial |
$1,081.50
|
| Rate for Payer: ASR ASR |
$1,165.61
|
| Rate for Payer: BCBS Trust/PPO |
$986.81
|
| Rate for Payer: BCN Commercial |
$986.81
|
| Rate for Payer: Cash Price |
$961.33
|
| Rate for Payer: Cofinity Commercial |
$1,129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.33
|
| Rate for Payer: Healthscope Commercial |
$1,165.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,201.66
|
| Rate for Payer: Mclaren Commercial |
$1,081.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.41
|
| Rate for Payer: Nomi Health Commercial |
$985.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,057.46
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,201.66
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$1,201.66 |
| Rate for Payer: Aetna Commercial |
$1,081.50
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$1,165.61
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$990.77
|
| Rate for Payer: BCN Commercial |
$990.77
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$961.33
|
| Rate for Payer: Cash Price |
$961.33
|
| Rate for Payer: Cofinity Commercial |
$1,129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$1,165.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,201.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$1,081.50
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.41
|
| Rate for Payer: Nomi Health Commercial |
$985.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,057.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.33 |
| Max. Negotiated Rate |
$167.11 |
| Rate for Payer: Aetna Commercial |
$150.40
|
| Rate for Payer: ASR ASR |
$162.09
|
| Rate for Payer: BCBS Trust/PPO |
$137.23
|
| Rate for Payer: BCN Commercial |
$137.23
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$157.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$162.09
|
| Rate for Payer: Healthscope Whirlpool |
$167.11
|
| Rate for Payer: Mclaren Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Nomi Health Commercial |
$137.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.05
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$167.11 |
| Rate for Payer: Aetna Commercial |
$150.40
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$162.09
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$137.78
|
| Rate for Payer: BCN Commercial |
$137.78
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$157.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$162.09
|
| Rate for Payer: Healthscope Whirlpool |
$167.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.88
|
| Rate for Payer: Mclaren Commercial |
$150.40
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Nomi Health Commercial |
$137.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$271.90
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$271.90 |
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: Aetna Commercial |
$480.86
|
| Rate for Payer: ASR ASR |
$263.75
|
| Rate for Payer: ASR ASR |
$518.26
|
| Rate for Payer: BCBS Trust/PPO |
$223.29
|
| Rate for Payer: BCBS Trust/PPO |
$438.75
|
| Rate for Payer: BCN Commercial |
$223.29
|
| Rate for Payer: BCN Commercial |
$438.75
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cofinity Commercial |
$502.23
|
| Rate for Payer: Cofinity Commercial |
$255.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.43
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Healthscope Commercial |
$518.26
|
| Rate for Payer: Healthscope Whirlpool |
$534.28
|
| Rate for Payer: Healthscope Whirlpool |
$271.90
|
| Rate for Payer: Mclaren Commercial |
$480.86
|
| Rate for Payer: Mclaren Commercial |
$244.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Nomi Health Commercial |
$438.11
|
| Rate for Payer: Nomi Health Commercial |
$222.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.28
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$271.90
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$271.90 |
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: Aetna Commercial |
$480.86
|
| Rate for Payer: Aetna Medicare |
$3.26
|
| Rate for Payer: Aetna Medicare |
$3.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: ASR ASR |
$263.75
|
| Rate for Payer: ASR ASR |
$518.26
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$440.52
|
| Rate for Payer: BCBS Trust/PPO |
$224.18
|
| Rate for Payer: BCN Commercial |
$440.52
|
| Rate for Payer: BCN Commercial |
$224.18
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cofinity Commercial |
$255.59
|
| Rate for Payer: Cofinity Commercial |
$502.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Healthscope Commercial |
$518.26
|
| Rate for Payer: Healthscope Whirlpool |
$271.90
|
| Rate for Payer: Healthscope Whirlpool |
$534.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.26
|
| Rate for Payer: Mclaren Commercial |
$480.86
|
| Rate for Payer: Mclaren Commercial |
$244.71
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$1.79
|
| Rate for Payer: Meridian Medicaid |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.14
|
| Rate for Payer: Nomi Health Commercial |
$438.11
|
| Rate for Payer: Nomi Health Commercial |
$222.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.71
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.59
|
| Rate for Payer: PHP Commercial |
$3.59
|
| Rate for Payer: PHP Medicaid |
$1.75
|
| Rate for Payer: PHP Medicaid |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Narrow Network |
$8.16
|
| Rate for Payer: Priority Health Narrow Network |
$8.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.05
|
| Rate for Payer: UHC Exchange |
$5.05
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP DNSP |
$3.26
|
| Rate for Payer: UHCCP DNSP |
$3.26
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$186.23
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$186.23 |
| Rate for Payer: Aetna Commercial |
$167.61
|
| Rate for Payer: Aetna Commercial |
$298.86
|
| Rate for Payer: Aetna Medicare |
$3.26
|
| Rate for Payer: Aetna Medicare |
$3.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: ASR ASR |
$180.65
|
| Rate for Payer: ASR ASR |
$322.10
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$273.79
|
| Rate for Payer: BCBS Trust/PPO |
$153.55
|
| Rate for Payer: BCN Commercial |
$273.79
|
| Rate for Payer: BCN Commercial |
$153.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$312.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$180.65
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Healthscope Whirlpool |
$186.23
|
| Rate for Payer: Healthscope Whirlpool |
$332.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.26
|
| Rate for Payer: Mclaren Commercial |
$298.86
|
| Rate for Payer: Mclaren Commercial |
$167.61
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$1.79
|
| Rate for Payer: Meridian Medicaid |
$1.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Nomi Health Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$152.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.05
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.59
|
| Rate for Payer: PHP Commercial |
$3.59
|
| Rate for Payer: PHP Medicaid |
$1.75
|
| Rate for Payer: PHP Medicaid |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Narrow Network |
$8.16
|
| Rate for Payer: Priority Health Narrow Network |
$8.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.05
|
| Rate for Payer: UHC Exchange |
$5.05
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP DNSP |
$3.26
|
| Rate for Payer: UHCCP DNSP |
$3.26
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.23
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.67 |
| Max. Negotiated Rate |
$186.23 |
| Rate for Payer: Aetna Commercial |
$167.61
|
| Rate for Payer: Aetna Commercial |
$298.86
|
| Rate for Payer: ASR ASR |
$180.65
|
| Rate for Payer: ASR ASR |
$322.10
|
| Rate for Payer: BCBS Trust/PPO |
$152.93
|
| Rate for Payer: BCBS Trust/PPO |
$272.69
|
| Rate for Payer: BCN Commercial |
$152.93
|
| Rate for Payer: BCN Commercial |
$272.69
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cofinity Commercial |
$312.14
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.65
|
| Rate for Payer: Healthscope Commercial |
$180.65
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Healthscope Whirlpool |
$332.07
|
| Rate for Payer: Healthscope Whirlpool |
$186.23
|
| Rate for Payer: Mclaren Commercial |
$298.86
|
| Rate for Payer: Mclaren Commercial |
$167.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Nomi Health Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$152.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.89
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,456.80 |
| Max. Negotiated Rate |
$8,609.07 |
| Rate for Payer: Aetna Commercial |
$7,748.16
|
| Rate for Payer: ASR ASR |
$8,350.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,069.77
|
| Rate for Payer: BCN Commercial |
$7,069.77
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$8,092.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Healthscope Commercial |
$8,350.80
|
| Rate for Payer: Healthscope Whirlpool |
$8,609.07
|
| Rate for Payer: Mclaren Commercial |
$7,748.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Nomi Health Commercial |
$7,059.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,575.98
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$8,609.07 |
| Rate for Payer: Aetna Commercial |
$7,748.16
|
| Rate for Payer: Aetna Medicare |
$20.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.69
|
| Rate for Payer: ASR ASR |
$8,350.80
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$20.55
|
| Rate for Payer: BCBS Trust/PPO |
$7,098.18
|
| Rate for Payer: BCN Commercial |
$7,098.18
|
| Rate for Payer: BCN Medicare Advantage |
$20.55
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$8,092.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$8,350.80
|
| Rate for Payer: Healthscope Whirlpool |
$8,609.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.55
|
| Rate for Payer: Mclaren Commercial |
$7,748.16
|
| Rate for Payer: Mclaren Medicaid |
$20.55
|
| Rate for Payer: Mclaren Medicare |
$20.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.58
|
| Rate for Payer: Meridian Medicaid |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Nomi Health Commercial |
$7,059.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: PACE Medicare |
$19.52
|
| Rate for Payer: PACE SWMI |
$20.55
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: PHP Medicaid |
$11.01
|
| Rate for Payer: PHP Medicare Advantage |
$20.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.28
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: Priority Health Narrow Network |
$17.02
|
| Rate for Payer: Railroad Medicare Medicare |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,575.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.55
|
| Rate for Payer: UHC Exchange |
$31.85
|
| Rate for Payer: UHC Medicaid |
$10.75
|
| Rate for Payer: UHCCP DNSP |
$20.55
|
| Rate for Payer: UHCCP Medicaid |
$10.75
|
| Rate for Payer: VA VA |
$20.55
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.65 |
| Max. Negotiated Rate |
$310.20 |
| Rate for Payer: Aetna Commercial |
$279.18
|
| Rate for Payer: ASR ASR |
$300.89
|
| Rate for Payer: BCBS Trust/PPO |
$254.74
|
| Rate for Payer: BCN Commercial |
$254.74
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$291.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$300.89
|
| Rate for Payer: Healthscope Whirlpool |
$310.20
|
| Rate for Payer: Mclaren Commercial |
$279.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.98
|
|
